Objective physical examination in cardiovascular diseases: visual examination

involves evaluation of the cardiovascular system. The exact contents of the examination will vary depending on the presenting complaint but a complete examination will involve the heart (cardiac examination), lungs (pulmonary examination), belly (abdominal examination) and the blood vessels (peripheral vascular examination).

comprising the following sections: measurement of vital signs; inspection and palpation; percussion and auscultation.

can lay eyes on the patient. Doctors will observe the color of skin, rate of breathing, and emotional state of their patients at a distance before the examination begins. An accurate blood pressure and heart rate should be measured, as these are direct measurements of how well the heart is working. An automatic blood pressure cuff can be used, but a healthcare professional can also use a manual blood pressure cuff and stethoscope. The bell of the stethoscope should be placed over the brachial artery when taking a blood pressure manually: the pressure meter when the first two heart beats are heard will show the systolic blood pressure; when the sounds disappear, the meter will show the diastolic blood pressure. A normal systolic blood pressure will be less than 120 mm Hg, and a normal diastolic blood pressure will be less than 80 mm Hg. A blood pressure that is more than 15 mm Hg different between the right and left arm may indicate a problem with the patient's blood vessels.A normal heart rate is between 60 and 100 beats per minute. This can be measured wherever a pulse can be felt, but is usually measured from the radial artery. Vital signs should be measured at least twice during each patient encounter, with as much time as possible between measurements (e.g. once at the beginning and once at the end of the appointment). A heart rate and rhythm that is normal may be written down as "RRR".

simple visual inspection. In the acutely unwell patient, cyanosis, pallor, and sweatiness can all be signs of impending danger – does the patient "look" ill? In nonacute patients, cachexia is perhaps the most important feature to note on general inspection since it is an important prognostic sign in heart failure. Palpation is essential to confirm that girth is excess fluid (pitting edema) Certain physical appearances should always prompt an awareness of cardiac abnormalities. Facial signs for which there is evidence of an association with cardiac conditions are shown in.Finally, it is important to document the condition of a potential cardiac patient's teeth.

systemic effects of cardiac disorders and evidence of noncardiac disorders that might affect the heart. Examination includes the following:
 Vital sign measurement
 Pulse palpation and auscultation 
Vein observation 
Chest inspection, and palpation 
Cardiac percussion, palpation, and auscultation Lung examination, including percussion, palpation, and auscultation
 Extremity and abdomen examination 
Cardiac auscultation is discussed in a separate topic. Despite the ever-increasing use of cardiac imaging, bedside auscultation remains useful as it is always available and can be repeated as often as desired without cost. 

indicator of previous surgery – eg, midline sternotomy suggests previous bypass, lateral thoracotomy suggests previous mitral valve or minimally invasive bypass surgery (left internal mammary artery to left anterior descending coronary artery). Locate the apex beat – the furthest point laterally and inferioraly where you can clearly feel the apex (usually the fifth intercostal space in the midclavicular line). There are many different descriptions for abnormal apex beats. One scheme distinguishes heaving (high afterload, eg, aortic stenosis) from thrusting (high preload, eg, aortic regurgitation). The apex may also be "tapping", but this reflects a loud first heart sound. In addition, you should place your left hand over the sternum and feel for any significant ventricular heave (right ventricular hypertrophy) or thrill (tight aortic stenosis, ventricular septal defect).

of auscultation remains, but is diminished in an age of increasingly portable echocardiography.Listen over the aortic (second right intercostal space) and pulmonary (second left intercostal space) areas and at the left lower sternal edge with the diaphragm of your stethoscope (better for higher pitches), then use the bell for the apex (better for lower pitches). If in doubt, use both. Press lightly with the bell. If you hear an abnormality over the aortic or pulmonary areas, you should listen over the carotids. If you hear an abnormality at the apex, listen in the axilla. Listen systematically. Start with the heart sounds – ignore everything else

addition in the clinical evaluation of the patient with heart disease. This skill has been largely lost with the advent of new imaging techniques such as X-ray and echocardiography, both of which are more accurate in defining cardiac size and borders and detecting the presence and extent of pericardial fluid. 
In the fast-paced world of modern medicine, do cardiologists spend time percussing the chest, trying to sort out if there is cardiomegaly or fluid in the pericardium, when in minutes they could have a more accurate and definitive diagnosis with echocardiography? The honest answer is no. However, cardiac percussion skill as well as knowledge of its implication might provide quick information at the bedside, most especially in significant pericardial effusion, pending confirmation with echocardiography

the day
Including fatty fish in the diet
Controlling diabetes if present 
Performing regular physical activity 
Not smoking